Gun Violence in Nashville

Manish K. Sethi, MD, is a health policy associate at the Robert Wood Johnson Foundation (RWJF)Center for Health Policy at Meharry Medical College and a Pilot Project Mini-Grant recipient and renowned orthopaedic trauma surgeon at Vanderbilt University’s Orthopaedic Institute Center for Health Policy. Sethi spoke this morning during the 2012-2013 Grand Rounds Series, sponsored by Meharry Medical College School of Medicine, on “Gun Violence in Nashville: Working Towards Community Based Solutions.”

Human Capital Blog: What is the violence prevention program you’re directing with the RWJF Center for Health Policy at Meharry?

Sethi: We are doing a youth violence intervention program via partnership with Nashville schools funded by the RWJF Center for Health Policy at Meharry.

All of the data demonstrates that educational intervention with this age group demonstrates positive results. Currently, no such program exists in Nashville schools.

HCB: What drove your interest in this topic?

Sethi: I am a trauma surgeon and have been seeing an inordinate number of gun violence injuries in African American teenagers. I grew up in Tennessee and left for my medical training, but during childhood I never saw violence to this degree. Almost every week I see a teenager who either loses his life, or suffers major trauma secondary to a gun violence injury. I care very deeply about the future of these children and of Tennessee and I just feel that we have to do something.

HCB: What are some best practices for violence prevention that you would recommend?

Sethi: I like to say that guns don't hurt people, instead people hurt people. We need to really focus on developing alternative conflict resolution strategies in our children.

There are many broader issues at play obviously, but I do believe that if we seek to educate our children to find peaceful ways to manage conflict, we can curb this tide of gun violence, as similar programs have done across the United States.

HCB: What type of conflict resolution practices are part of your pilot violence prevention program?

Sethi: Essentially the program works by giving children tools they can utilize to avoid violence, which down the road hopefully stems the tide of things like gun violence. We use examples. For instance, if an individual tries to start a fight with you, how do you respond and resolve the situation without violence? Say two people in front of you are about to start fighting, how can you calm the situation?

HCB: What are your plans for future study or work on violence prevention?

Sethi: We are currently working on a pilot program which will conclude in December 2012. Once this is complete, we are hoping to introduce similar programs into schools across Nashville with the support of the Metro Public School System.

HCB: You also published a study on defensive medicine with your colleague Alex Jahangir. What is defensive medicine, and why do health care professionals use these medical practices?

Sethi: Defensive medicine is when providers practice medicine based upon the fear of malpractice and make decisions predicated upon this fear instead of the standard of care. Physicians across America practice defensive medicine, i.e. order extra X-rays, tests, labs, etc. as they are essentially afraid of being sued for missing something.

HCB: What did your study look at, and how did you collect data?

Sethi: I have been the lead author of two studies; the first was in Massachusetts where we sent surveys to 1,000 physicians across specialties asking them what tests they order based upon the fear of being sued. We did a similar study targeting Orthopaedic surgeons across the United States. Both demonstrated that approximately 30 percent of tests are ordered out of fear of liability. In the case of the Orthopaedic surgeons, that is roughly $2 billion annually.

HCB: Do your findings have implications for health professionals or policy-makers? Do you plan to study this topic further?

Sethi: I think it points to the need to develop clinical practice guidelines that, if followed, can indemnify physicians. I believe that this is a critical issue that we must further study.

This commentary originally appeared on the RWJF Human Capital Blog. The views and opinions expressed here are those of the authors.

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